Vascular imaging: nutcracker syndrome: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Vascular imaging: nutcracker syndrome

Sample item

A young woman with left flank pain and haematuria has CT showing compression of the left renal vein between the superior mesenteric artery and the aorta, with dilatation of the vein proximal to it. What is this syndrome?

AMedian arcuate ligament syndromeBNutcracker syndromeCSuperior mesenteric artery syndromeDMay-Thurner syndrome

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Nutcracker syndrome

In nutcracker syndrome the left renal vein is squeezed in the aortomesenteric angle, which raises venous pressure and causes haematuria, flank pain and sometimes left varicocele. Doppler or CT shows a high velocity ratio across the compression.

Option by option

A. Median arcuate ligament syndrome
Median arcuate ligament syndrome compresses the coeliac trunk.
B. Nutcracker syndrome (correct)
Correct. Left renal vein compression by the SMA and aorta is the nutcracker phenomenon.
C. Superior mesenteric artery syndrome
SMA syndrome compresses the third part of the duodenum.
D. May-Thurner syndrome
May-Thurner involves compression of the left common iliac vein by the right common iliac artery.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Nutcracker syndrome. In nutcracker syndrome the left renal vein is squeezed in the aortomesenteric angle, which raises venous pressure and causes haematuria, flank pain and sometimes left varicocele.

Why is "Median arcuate ligament syndrome" not the answer?

Median arcuate ligament syndrome compresses the coeliac trunk.

Why is "Superior mesenteric artery syndrome" not the answer?

SMA syndrome compresses the third part of the duodenum.

Why is "May-Thurner syndrome" not the answer?

May-Thurner involves compression of the left common iliac vein by the right common iliac artery.

What concept does this question test?

It tests Vascular imaging: nutcracker syndrome in Radiology. Doppler or CT shows a high velocity ratio across the compression.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vascular imaging: nutcracker syndrome?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.